---
title: Patient Page
description: New Patient Forms Packet (includes the forms below for your first visit); Patient Registration · Patient Health History · Practice and Financial Agreement
---

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- [Home](https://blackhawkmedicalgroup.com)
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    - [Concierge Medicine](https://blackhawkmedicalgroup.com/concierge-medicine)
- [Walk-in Clinic](https://blackhawkmedicalgroup.com/walk-in-clinic)
- [Patients](https://blackhawkmedicalgroup.com/patient-page) 
    - [Patient Forms](https://blackhawkmedicalgroup.com/patient-forms)
    - [New Patient Info](https://blackhawkmedicalgroup.com/patient-page)
    - [FAQs](https://blackhawkmedicalgroup.com/faqs)
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    - [Resources](https://blackhawkmedicalgroup.com/blog)
- [Contact](https://blackhawkmedicalgroup.com/contact)

# Patient Forms

Home - Patient Forms

### Important Information

- [**New Patient Welcome Letter**](https://blackhawkmedicalgroup.com/hubfs/2020-jan-new-patient-letter.pdf?hsLang=en)
- [**Medicare Wellness Visits**](https://blackhawkmedicalgroup.com/your-medicare-wellness-visits?hsLang=en)
- [**Your Annual Physical**](https://blackhawkmedicalgroup.com/your-annual-physical?hs_preview=eRouGqlK-106387652489&hsLang=en)

### Patient Forms

Signature Required\*

- [New Patient Forms Packet \*](https://blackhawkmedicalgroup.medforward.com/FillOutForm.aspx?formname=New_Patient_Packet)(includes the forms below for your first visit)
- [Patient Registration \*](https://blackhawkmedicalgroup.medforward.com/FillOutForm.aspx?formname=Registration_Packet)
- [Consent for Care of a Minor](https://blackhawkmedicalgroup.com/hubfs/2020-jan-consent-for-care-minor.pdf?hsLang=en)
- [Request to Obtain Medical Records](https://blackhawkmedicalgroup.com/hubfs/2020-jan-request-obtain-medical-records.pdf?hsLang=en)
- [Medication Contract](https://blackhawkmedicalgroup.com/hubfs/pt-medication-contract.pdf?hsLang=en)

 

![BMG Designed Scenery\_1](https://blackhawkmedicalgroup.com/hubfs/BMG%20Designed%20Scenery_1.png "BMG Designed Scenery_1")

### Participating Insurances

 Aetna   
Aetna Medicare Advantage PPO   
Anthem Blue Cross Medicare Advantage PPO   
Anthem Blue Cross of CA   
Anthem Blue Cross of CA Prudent Buyer Plan(all metals)   
Anthem Blue Cross JM Healthy Employee PPO   
Blue Cross PPO   
BCBS Blue Edge   
Blue Shield of CA   
Blue Shield of CA UC Care(tier 2)   
Blue Shield PERS Platinum PPO   
Blue Shield PERS Gold Select PPO   
Blue Shield Covered California   
Blue Shield CalPERS Active Access+ HMO(JMPN only)   
First Health PPO   
HealthNet PPO   
Health Partners(Cigna other payer)   
Humana Medicare PPO   
John Muir HMO   
JMPN Aetna   
JMPN Anthem Blue Cross   
JMPN Blue Shield   
JMPN Canopy(NO Medicare Advantage)   
JMPN HealthNet   
Kaiser PPO   
Medicare   
Medigap   
Meritain Health   
Multiplan   
Pacific Health Alliance   
PHCS   
Tricare   
TriWest Healthcare Alliance   
UHC   
UHC Core   
UHC JM Group Retiree   
UHC Medicare Advantage PPO   
UMR PPO   
Wellabe Medicare Supplement   
Workers Comp- ONLY Blackhawk Country Club

### Non-Contracted Insurance Carriers

 Affinity Medical Group   
Anthem Blue Cross Covered CA - metal plans(silver, gold, platinum)   
Anthem Blue Cross UC Select PPO/EPO   
Anthem Blue Cross University of CA Student Plan   
Blue Cross Pathway PPO/EPO   
Brown and Tolland   
Community Health Center   
Health Net - Medicare HMO and PPO   
Hill Physicians   
Imperial Health Plan   
JMPN Bright Healthcare   
JMPN Central Health   
Kaiser HMO   
MedPay, Medi-Share Health Ministry   
Motor Vehicle Insurance   
Sutter   
UHC Canopy   
UHC Medicare Canopy   
Wellcare HMO

### Request an Appointment

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#### About

[Providers](https://blackhawkmedicalgroup.com/our-providers?hsLang=en)  
[Locations](https://blackhawkmedicalgroup.com/locations?hsLang=en)  
[Services](https://blackhawkmedicalgroup.com/services?hsLang=en)  
[Insurance](https://blackhawkmedicalgroup.com/accepted-insurances?hsLang=en)  
[Contact](https://blackhawkmedicalgroup.com/contact?hsLang=en)

#### Services

[Family Medicine](https://blackhawkmedicalgroup.com/family-medicine?hsLang=en)  
[Pediatrics](https://blackhawkmedicalgroup.com/pediatrics?hsLang=en)  
[Walk-in Clinic](https://blackhawkmedicalgroup.com/walk-in-clinic?hsLang=en)  
[Screenings](https://blackhawkmedicalgroup.com/screening-tests?hsLang=en)  
[Immunizations](https://blackhawkmedicalgroup.com/immunizations?hsLang=en)

#### Fine Print

[Privacy Policy](https://blackhawkmedicalgroup.com/?hsLang=en)  
[Disclaimer](https://blackhawkmedicalgroup.com/?hsLang=en)  
Sitemap  
[Patient Forms](https://blackhawkmedicalgroup.com/patient-forms?hsLang=en)  
[Resources](https://blackhawkmedicalgroup.com/blog?hsLang=en)

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